Quaking Hands
Yesterday and today I was the only vet in the clinic. Never my favorite scenario, but it went okay. Yesterday was dreadfully slow in the morning, today was busy all day long. I just recently got back from giving a goat a shot.
One of the good and bad things about being the only vet in the clinic or being on call is that I get to do things I would not get to do otherwise. Sometimes I wonder why I am not shown how to do things while other doctors are around. But I guess they are too busy. For instance, I performed my first dog cesarean section with no doctors and no technicians to assist. A little foolhardy, perhaps, but it went fine.
Today I did an intraperitoneal plasma transfusion on an alpaca cria -- never saw one done, never did one myself before. I had discussion with the owners regarding which side of the abdomen to insert the catheter. At OSU we did right-sided abdominocentesis on adult llamas, so it made sense to me that I would feed the plasma into that same spot (assuming that is the largest pocket of free fluid near the abdominal wall). As it turns out, Dr R feeds the plasma into the left side. Maybe this is better in crias as opposed to adults. Dunno.
We ended the discussion by finding notes regarding transfusion of another cria by Dr R, and I followed that protocol.
I shaved the left paralumber fossa, scrubbed it, placed a carbocaine block to numb the area. I poised my hand above the abdomen with the 14G 2" catheter grasped between thumb and forefinger. I began to insert the needle into the skin/muscle layers and then checked to ensure I was into the peritoneal space by advancing the plastic catheter ahead of the needle. If it slides easily, you're good. If not, you pull it back and advance the needle farther. I felt the pop as the needle entered the peritoneal space, advanced the catheter tube and pulled the needle out. I flushed the catheter with heparinized saline and drew back to ensure that, #1 fluid entered easily (indicating I was not between muscle bellies) and #2, I was not in the stomach. Both criteria met, we let the plasma flow
The owner commented "You're hands are shaking, that doesn't make me feel very good." Yes, I know. My hands shake when I am stressed, even when I have confidence that I can accomplish a task. It's that fear of "what if I fail," even though I know I have the ability to perform well. For instance, at the wedding last weekend, I started to shake briefly before I walked up the aisle. Not that I had any lack of confidence that I was capable of walking up the aisle, but stressed nonetheless. Fear of the unknown. Once I have done something once before, my brain has a pattern laid out and is much calmer. When I'm hypoglycemic and stressed, it's the worst. I guess if I was completely self-confident in spite of anything, my hands wouldn't shake. But it wouldn't mean I'd do a better job.
One of the good and bad things about being the only vet in the clinic or being on call is that I get to do things I would not get to do otherwise. Sometimes I wonder why I am not shown how to do things while other doctors are around. But I guess they are too busy. For instance, I performed my first dog cesarean section with no doctors and no technicians to assist. A little foolhardy, perhaps, but it went fine.
Today I did an intraperitoneal plasma transfusion on an alpaca cria -- never saw one done, never did one myself before. I had discussion with the owners regarding which side of the abdomen to insert the catheter. At OSU we did right-sided abdominocentesis on adult llamas, so it made sense to me that I would feed the plasma into that same spot (assuming that is the largest pocket of free fluid near the abdominal wall). As it turns out, Dr R feeds the plasma into the left side. Maybe this is better in crias as opposed to adults. Dunno.
We ended the discussion by finding notes regarding transfusion of another cria by Dr R, and I followed that protocol.
I shaved the left paralumber fossa, scrubbed it, placed a carbocaine block to numb the area. I poised my hand above the abdomen with the 14G 2" catheter grasped between thumb and forefinger. I began to insert the needle into the skin/muscle layers and then checked to ensure I was into the peritoneal space by advancing the plastic catheter ahead of the needle. If it slides easily, you're good. If not, you pull it back and advance the needle farther. I felt the pop as the needle entered the peritoneal space, advanced the catheter tube and pulled the needle out. I flushed the catheter with heparinized saline and drew back to ensure that, #1 fluid entered easily (indicating I was not between muscle bellies) and #2, I was not in the stomach. Both criteria met, we let the plasma flow
The owner commented "You're hands are shaking, that doesn't make me feel very good." Yes, I know. My hands shake when I am stressed, even when I have confidence that I can accomplish a task. It's that fear of "what if I fail," even though I know I have the ability to perform well. For instance, at the wedding last weekend, I started to shake briefly before I walked up the aisle. Not that I had any lack of confidence that I was capable of walking up the aisle, but stressed nonetheless. Fear of the unknown. Once I have done something once before, my brain has a pattern laid out and is much calmer. When I'm hypoglycemic and stressed, it's the worst. I guess if I was completely self-confident in spite of anything, my hands wouldn't shake. But it wouldn't mean I'd do a better job.
posted by Claire at 20:15
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